Analysis of time to death for children with life-threatening hemorrhage from traumatic, surgical, and medical etiologies.

Abstract

Introduction: Life-threatening hemorrhage (LTH) is a significant cause of mortality in pediatrics. Timing of mortality in children with LTH is important for future trials.

Methods: In a secondary analysis of the prospective observational massive transfusion in children (MATIC) study, time-to-event analysis was performed to determine timing of death based on etiology of LTH and cause of death.

Results: There were 449 children with LTH; the etiologies of LTHs included trauma (46%), operative (34%), and medical (20%). The cause of death at 24 h in the trauma group was 56% from hemorrhage and 42% from central nervous system (CNS) failure; in operative group it was 94% from hemorrhage and 6% CNS failure; in medical group it was 84% hemorrhage and 3% CNS failure. The median (interquartile range [IQR]) time to death (hours) varied by cause of death (hemorrhagic: 3.3 [1.0-10.3], CNS failure: 30.4 [9.0-63.6]). For traumatic LTH, 90% of hemorrhage-related deaths occurred within 19 h and 90% of CNS failure deaths occurred within 92 h. For operative LTH, 90% of hemorrhage-related deaths occurred within 5 days and 90% of CNS failure deaths occurred within 28 days. For medical LTH, 90% of hemorrhage-related deaths occurred within 44 h and 90% of CNS failure deaths occurred within 24 days.

Conclusion: In children, timing of death differs according to etiology of LTH and by cause of death. The choice of primary outcome for trials in children with LTH should consider these differences based on the etiology of LTH being studied.